12 research outputs found
Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study
Background: This study was designed to compare the efficacy of an
intraoperative single dose administration of tramadol and
dexmedetomidine on hemodynamics and postoperative recovery profile
including pain, sedation, emerge reactions in pediatric patients
undergoing adenotonsillectomy with sevoflurane anesthesia.
Methods: Seventy-seven patient, aged 2-12, undergoing adenotonsillectomy
with sevoflurane anesthesia was enrolled in this study. Patients were
randomly assigned to receive either intravenous 2 mg/kg tramadol (Group
T; n = 39) or 1 mu g/kg dexmedetomidine (Group D; n = 38) after
intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded
before induction, at induction and every 5 min after induction.
Observational pain scores (OPS), pediatric anesthesia emergence delirium
(PAED) scores, percentage of patients with OPS = 4 or PAED scale items 4
or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were
recorded on arrival to the postoperative care unit (PACU) and at 5, 10,
15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9
were recorded.
Results: Dexmedetomidine significantly decreased the HR and MAP 10 and
15 min after induction; increased the RSS 15, 30 and 45 min after
arrival to PACU. OPS and PAED scores and percentage of patients with OPS
= 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both
groups did not show any significant difference. Extubation time and time
to have Alderete score > 9 was significantly longer in Group D.
Conclusion: Both tramadol and dexmedetomidine were effective for
controlling pain and emergence agitation. When compared with tramadol
intraoperative hypotension, bradycardia and prolonged sedation were
problems related with dexmedetomidine administration
A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy
Study Objective: The purpose of this study was to compare the clinical activities of ketamine and fentanyl when used in combination with propofol for outpatients undergoing endometrial biopsy. The investigated parameters were respiration, sedation, recovery rate, side effects, time to discharge, and patient satisfaction
Hipertansif Hastalarda Entübasyona Hemodinamik Yanıt Sevofluran İndüksiyonu İle Önlenebilir Mi
Sevoflurane exerts brain-protective effects against sepsis-associated encephalopathy and memory impairment through caspase 3/9 and Bax/Bcl signaling pathway in a rat model of sepsis
Objective We compared the effects of sevoflurane and isoflurane on
systemic inflammation, sepsis-associated encephalopathy, and memory
impairment in a rat sepsis model of cecal ligation and puncture
(CLP)-induced polymicrobial peritonitis.
Methods Twenty-four rats were assigned to sham, CLP, CLP+sevoflurane,
and CLP+isoflurane groups. At 72 hours after CLP, the rats underwent
behavior tests. Serum cytokines were evaluated. Brain tissue samples
were collected for determination of glutathione peroxidase (GPX),
superoxide dismutase (SOD), and catalase; the wet/dry weight ratio;
myeloperoxidase (MPO) and malondialdehyde (MDA); apoptotic gene release;
and histologic examinations.
Results The MPO level, wet/dry weight ratio, and histopathology scores
were lower and the Bcl2a1 and Bcl2l2 expressions were upregulated in
both the CLP+sevoflurane and CLP+isoflurane groups compared with the CLP
group. The interleukin-6, interleukin-1, MDA, and caspase 3, 8, and 9
levels were lower; the GPX, SOD, Bax, Bcl2, and Bclx levels were higher;
and non-associative and aversive memory were improved in the
CLP+sevoflurane group compared with the CLP+isoflurane group.
Conclusion Sevoflurane decreased apoptosis and oxidative injury and
improved memory in this experimental rat model of CLP. Sevoflurane
sedation may protect against brain injury and memory impairment in
septic patients
Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery A case report with the literature review
Rationale: Sugammadex is a cylodextrin derivate that encapsulates
steroidal neuromuscular blocker agents and is reported as a safe and
well-tolerated drug. In this case report, we present a patient who
developed grade 3 anaphylaxis just after sugammadex administration.
Patient concerns: A 22-year-old woman with diagnosis of Weaver syndrome
was scheduled for bilateral mammoplasty and resection of unilateral
accessory breast tissue resection. Anesthesia was induced and maintained
by propofol, rocuronium, and remifentanil. At the end of the operation,
sugammadex was administered and resulted in initially hypotension and
bradycardia then the situation worsened by premature ventricular
contraction and bigeminy with tachycardia, bronchospasm, and hypoxia.
Diagnosis: The Ring and Messmer clinical severity scale grade 3
anaphylactic reaction occurred just after sugammadex injection and the
patient developed prolonged hypotension with recurrent cardiac
arrhythmias in postoperative 12 hours.
Interventions: Treatment was initiated bolus injections of ephedrine,
epinephrine, lidocaine, steroids and antihistaminic and continued with
lidocaine bolus dosages and norepinephrine infusion for the
postoperative period.
Outcomes: The general condition of the patient improved to normal 3
hours after the sugammadex injection, and she was moved to the intensive
care unit. At 2nd and 8th hours of intensive care unit follow-up, she
developed premature ventricular contraction and bigeminy with the heart
rate of 130 to 135 beats/min, which returned to sinus rhythm with 50 mg
lidocaine. After that, no symptoms were observed and the patient was
discharged to plastic surgery clinic at the following day.
Lessons: Sugammadex may result in life-treating anaphylactic reaction
even in a patient who did not previously expose to drug. Moreover,
prolonged cardiovascular collapse and cardiac arrhythmias may occur
Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine model
Background/aim: This study was undertaken to evaluate the effects of
positive end-expiratory pressure (PEEP) levels on intracranial pressure
(ICP) and cerebral perfusion pressure (CPP) and to determine the
appropriate PEEP level during steep Trendelenburg position combined with
pneumoperitoneum.
Materials and methods: Ten pigs were included in this study.
Pneumoperitoneum and Trendelenburg position were maintained and PEEP
titration was initiated. Arterial pressure, heart rate, arterial blood
gas, ICP, and CPP were recorded at the following time points: baseline
(T0), 30 min after positioning and pneumoperitoneum (T1), PEEP 5 (T2),
PEEP 10 (T3), PEEP 15 (T4), and PEEP 20 (T5).
Results: MAP significantly increased at T1 compared to T0 and decreased
at T4 and T5 compared to T1. ICP was 9.5 mmHg and CPP was 69.3 mmHg at
T0. CO2 insufflation and steep Trendelenburg position did not cause any
significant difference in ICP and CPP. ICP increased and CPP decreased
significantly at T4 and T5 compared to both T0 and T1. PaO2 and
PaO2/FiO(2) decreased significantly at T1 and T2 compared to T0, while
both increased significantly at T3, T4, and T5 compared to T1.
Conclusion: PEEP of 10 cmH(2)O was effective for providing oxygenation
while preserving hemodynamic stability, ICP, and CPP in this model
Comparison Of The Effects Of Dexmedetomidine Vs. Ketamine In Cardiac Ischemia/Reperfusion Injury In Rats - Preliminary Study
Objectives. Following ischemia/reperfusion injury, antioxidant defense mechanisms may remain insufficient depending on the duration of ischemia which is caused by any reason (MI, after percutaneous coronary intervention, during cardiac surgery). After that, free oxygen radicals increasing within the cell cause structural deterioration. Cytokines which activate a series of reactions that cause tissue damage and inflammatory response are released during reperfusion of ischemic tissues. In this study, we aimed to compare the effects of dexmedetomidine and ketamine in cardiac ischemia/reperfusion injury. Material and Methods. The study included 18 rats randomly divided into three groups. Group I/R (n = 6): control, Group I/R-K (n = 6): ketamine, and Group I/R-D (n = 6): dexmedetomidine. Before the 10 min surgery, after the 20 min ischemia and 20 min reperfusion period, hemodynamic parameters were compared among the three groups. After the 45 min ischemia and 120 min reperfusion period, tissue samples were obtained from the rat hearts, and MDA, SOD, GSH-Px, IL-1 beta and TNF-alpha levels were compared. Results. MDA and GSH-Px levels were significantly higher in the control group compared to the ketamine and dexmedetomidine groups. However, both levels were similar in the ketamine and dexmedetomidine groups. SOD levels were significantly lower in the ketamine and dexmedetomidine groups compared to the control group, but they were similar in the ketamine and dexmedetomidine groups. IL-1 beta levels were similar in all groups. TNF-alpha levels were significantly lower in the ketamine and dexmedetomidine groups compared to the control group. They were similar in the ketamine and dexmedetomidine groups. Conclusions. According to our study, it can be concluded that dexmedetomidine and ketamine have similar effects on reducing myocardial ischemia reperfusion injury. Dexmedetomidine provides better heart rate control but causes hypotension, so, because of cardiac depression, we think that its clinical use may necessitate further investigationWoSScopu